Page 1 of 3

    Food Service Establishment
X Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM021  
    Pre-opening
X Original Inspection
    Reinspection
   Follow-Up
    Possible FBI
    Complaint
   Other
Name of Establishment  DOLLAR GENERAL STORE #2303 Address  200 N DIXIE HWY
Owner or Operator   DG RETAIL LLC City   MOMENCE Zip Code   60954
 
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
 
FOOD
18
 
1
 Pre-flushed, scraped, soaked
34
  
1
 Outside storage area, enclosures properly constructed, clean: controlled incineration
*1
  
5
 Source, Wholesome, No Spoilage
19
  
2
 Wash, rinse after: clean, proper temperature
2
  
1
 Original Container, Properly Labeled
*20
  
4
 Sanitization rinse: Clean, temperature, concentration   INSECT, RODENT ANIMAL CONTROL
 
FOOD PROTECTION
*35
  
4
 Presence of insects/rodents - outer openings protected; no birds, turtles, or other animals
*3
  
5
 Potentially hazardous food meets temperature requirements during storage, preparation, display, service and transportation
21
  
1
 Wiping cloths: clean, use restricted
22
X
2
 Food contact surfaces of equipment and utensils clean, free of abrasives and detergents  
FLOORS WALLS AND CEILINGS
36
  
1
 Floor: constructed, drained, clean, good repair, covering installation, dustless cleaning methods
*4
  
4
 Facilities to maintain product temperature
23
X
1
 Non-food contact surfaces of equipment and utensils clean
5
X
1
 Thermometers provided and conspicuous
37
  
1
 Walls, ceiling, attached equipment: constructed good repair, clean surfaces, dustless cleaning methods
6
 
2
 Potentially hazardous food properly thawed
24
  
1
 Storage, handling of clean equipment utensils
*7
  
4
 Unwrapped and potentially hazardous food not re-served, Cross Contamination
25
  
1
 Single-service articles, storage, dispensing  
LIGHTING
26
  
2
 No re-use of single-service articles
38
  
1
 Lighting provided as required - Fixtures shielded
8
  
2
 Food protection during storage, preparation, display, service and transportation  
WATER
  
VENTILATION
*27
 
5
 Water source, safe: Hot and cold under pressure
39
  
1
 Rooms and equipment - vented as required
9
  
2
 Handling of food(ice) minimized, methods  
SEWAGE
  
DRESSING ROOMS
10
  
1
 Food(ice) dispensing utensils properly stored
*28
  
4
 Sewage and waste water disposal
40
  
1
 Rooms clean, lockers provided, facilities clean
 
PERSONNEL
  
PLUMBING
  
OTHER OPERATIONS
*11
  
5
 Personnel with infections restricted
29
  
1
 Installed, maintained
*41
  
5
 Toxic items properly stored, labeled and used
*12
  
5
 Hands washed and clean, good hygienic practices
*30
 
5
 Cross-connection, back siphonage-backflow
42
  
1
 Premises: maintained, free of litter, unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel
13
  
1
Clean clothes, hair restraints
  
TOILET AND HAND-WASHING FACILITIES
 
FOOD EQUIPMENT AND UTENSILS
14
  
2
 Food (ice) contact surfaces: designed, constructed, maintained, installed, located
*31
  
4
 Number, convenient, accessible, designed, installed
43
  
1
 Complete separation from living/sleeping quarters, laundry
32
X
2
 Toilet rooms enclosed, self-closing doors, fixtures, good repair, clean: Hand cleanser, sanitary towels/hand drying devices provided. Proper waste receptacles, tissue
15
  
1
 Non-food (ice) contact surfaces: designed, constructed, maintained, installed, located.
44
  
1
 Clean, soiled linen properly stored
 
CERTIFIED PERSONNEL
16
  
2
 Dishwashing facilities: designed, constructed, maintained, installed, located, operated
*45
     Management personnel certified Yes     No     Registered for class    
 
GARBAGE AND REFUSE DIPSOSAL
17
  
1
 Accurate thermometers, chemical test kits provided, gauge cook
33
  
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   N/A ppm                   Dishwasher Temperature   N/A °F or label
Food Temperatures:   ICE CREAM 0°, FROZEN(PIZZA, SHRIMP) 0°, HAM & BACON & SAUSAGE 36°.
 
General Comments
HACCP CONCEPT DISCUSSED: PROPER PRACTICE OF STORING ALL GOODS AND FOOD ITEMS IN CLEAN SOUND CONDITION. 
Report and Instructions Received By   JASON /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  01/25/2017 Time In  2:00 PM Time Out  3:15 PM Sanitation Score  94 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  94  
 
Page 2 of 3

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM021  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  DOLLAR GENERAL STORE #2303 Address  200 N DIXIE HWY
Owner or Operator   DG RETAIL LLC City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
5  Observed no thermometer to be available in the following units: (1) freezer where pizza and shrimp were stored (2) cooler where eggs and bacon were stored. Foods in those two units were in good temperature though. Provide for an accurate, conspicuous thermometer, that is accurate within +/- 3°F, to be available in all units holding potentially hazardous foods. (750.140) Next Inspection
22  Observed the following food contact surfaces to be unclean: (1) found spills and food debris on the bottom of shelf in cooler where eggs and sausage. (2) found black dirt (or mold) and food debris where milks and orange juice were stored. Clean and maintain. (750.800) Next Inspection
23  Observed the following contact surfaces to be unclean: door gasket and inside glass part on the cooler door right next to cashers. Clean and maintain. (750.800) Next Inspection
32  Observed no soap and/or paper towels at the following hand sink(s): Customer's restroom had no paper towel. Provide for all handsinks to have supply of soap and paper towels to assure that proper handwashing occurs. (750.1120) Next Inspection
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   JASON /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  01/25/2017 Time In  2:00 PM Time Out  3:15 PM Sanitation Score  94 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  94  
 
Page 3 of 3

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   MM021  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  DOLLAR GENERAL STORE #2303 Address  200 N DIXIE HWY
Owner or Operator   DG RETAIL LLC City   MOMENCE Zip Code   60954
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
     
Report and Instructions Received By   JASON /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  01/25/2017 Time In  2:00 PM Time Out  3:15 PM Sanitation Score  94 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  94